After discharge from forensic psychiatric hospital, rates of violent reoffending are reported to range from 2% to 8% per year in high income countries. Risk assessment informs decisions around admission to and discharge from secure psychiatric hospital and contributes to treatment and supervision Current approaches to assess violence risk in secure hospitals are resource intensive, limited by accuracy and authorship bias. Forensic Violence Oxford (FoVOx) was developed using all forensic psychiatric patients in Sweden, based on the largest forensic psychiatric sample to date, and has the advantage of using routinely available data, which are less liable to bias than interview-based measures.

Literature review on the Forensic Psychiatry and Violence Oxford (FoVOx) tool.

Pubmed and Google Scholar search

The 12 items within the FoVOx tool are sex, age, previous violent crime, previous serious violent crime, primary discharge diagnosis, drug use disorder at point of hospitalization or discharge, any lifetime drug use disorder, alcohol use disorder at point of hospitalization or discharge, personality disorder at discharge, employment at admission, five or more prior inpatient episodes, and whether current length of stay has exceeded one year.

The FoVOx tool is scalable, quick, free to use and available online. Its use could enable clinicians to provide a reasonably accurate risk assessment in a brief and cost-effective way, and free up time to focus on clinical care and risk management rather than risk assessment.

The evidence that supports an association between domestic violence and abuse (DVA) perpetration and mental disorders is increasing. Since 2011, authorities in England and Wales have been required to conduct Domestic Homicide Reviews (DHRs) into deaths caused by violence, abuse or neglect of individuals aged 16 or over, by a family member or a current or ex-partner.

The aim of the study is to describe the characteristics of perpetrators of domestic homicide in a sample of DHR reports in which the perpetrator was known to mental health services in the 12 months before the offence. This sample will undergo qualitative framework analysis as part of another study conducted by the authors.

The researchers compiled a list of DHRs available online and randomly sampled 168 reports; in 20 of those reports, the perpetrators were under the care of mental health services in the 12 months prior to the offence. We have applied descriptive statistics to report on the sample characteristics.

The common mental illnesses diagnosed amongst perpetrators were depression (20%), anxiety (15%) and schizophrenia (15%). 25% of the perpetrators didn’t have a psychiatric diagnosis and 70% had a history of self-harm and suicidal ideation. Substance use was prevalent (60%). Half of the homicides involved children.

This report describes the demographic and mental health characteristics of a sample of perpetrators of domestic homicides. Further research is needed into the patterns of mental health service use by DVA perpetrators in order to improve identification and risk management.

No significant relationships.

Criminality has become of increasing concern in the practice of psychiatry. However, violence among elderly psychiatric patients is an underestimated and understudied phenomenon.

The aim of the study is to identify differences in the socio-demographic, clinical and criminological profiles between elderly criminals under treatment for psychiatric disorders and those not known to have mental disorders prior to the criminal offense in Tunisia.

We present a retrospective study on twenty male criminal mental patients, aged sixty years or older, who were hospitalized in the Forensic Psychiatry Department of Razi Hospital during 18 years, following a dismissal for insanity under Article 38 of the Penal Code and Article 29 of Law 92/83 on Mental Health.

Prevalence was higher among elderly criminals without a known psychiatric history (2.42% versus 1.98%). The average age was roughly the same, around 73 years old.Neurological and cardiovascular histories were the most common in both groups. The criminal act was indicative of dementia in 8 cases. Criminal history was more frequent in elderly patients with a personal psychiatric history (55.5% versus 18.2%). Patients whose act was revelatory of their mental disorder committed more violent crimes (63.7% versus 44.4%) using blunt objects (71.4% versus 0%).The victim most often belonged to the aggressor’s family, particularly the spouse (87.5%).

Screening for criminal risk factors in the elderly, early diagnosis of mental disorders and a comprehensive therapeutic project are necessary to prevent the risk of violent behaviour.

Recently video gaming, have attracted considerable attention for its possible beneficial therapeutic effects, the possibility for testing behavior in safe artificial environments and as a tool for professionals and patients to build specific competencies for the everyday life. Also, a substantial amount of research suggests that videogaming might improve the participants social and cognitive skills and emotional regulation. There is little or no evidence that videogaming increases long term aggression or leads to physical aggression. At a medium secure forensic psychiatric in-patient ward, the patients and staff engage in weekly E – Sport sessions (primarily counterstrike) to further the recovery process.

To provide a standardized description of how E-sport is organized and used in the recovery process among forensic psychiatric patients.

The Template for Intervention Description and Replication (TIDieR) checklist and guide is widely used to in health research to describe interventions in clinical trials and other health research contexts. By use of TIDieR we describe a newly developed E-sport intervention, in which staff members and patients in a medium secure forensic psychiatric ward engage in weekly E-Sport sessions (primarily counterstrike) to improve patient–staff relationship.

The E-sport intervention is detailed by use of the 12 TIDieR items and practical experiences and insights will be described.

This standardized and detailed description of how is used in a recovery-oriented process in forensic psychiatry can be used for future studies that wishes to implement the intervention or for research studies replicating the treatment.

No significant relationships.

Mental illness may explain some acting outs, but it does not necessarily lead to a dangerous attitude.

Describe the socio-demographic, clinical and therapeutic characteristics of patients considered dangerous and to identify the determinants of psychiatric dangerousness.

We carried out a descriptive and analytical cross-sectional study during six months including patients hospitalized in the psychiatric department at the University Hospital of Mahdia. The data was collected using a 47-item pre-established questionnaire. The assessment of general psychopathology was carried out using the Brief Psychiatric Rating Scale (BPRS) and that of dangerousness using the Historical Clinical Risk-20 scale (HCR-20).

We have collected 143 patients. The average age was 35 years. The majority of patients were single (70.6%). More than half of the population had addictive behaviors (60.1%). Personal psychiatric and criminal histories were present in 81.1% and 11.9% of cases respectively. More than three-quarters of patients (81.8%) were hospitalized without their consent. Hetero-aggressiveness was the main reason for hospitalization (67.8%). The diagnosis was schizophrenia and bipolar disorder type 2 in 21% of cases for each. The evaluation of psychiatric dangerousness by the HCR-20 scale revealed a mean score of 20.6 with an HCR-20 > 20 in 58.7% of cases indicating a high risk of violence. Factors contributing to violent or criminal behavior in psychiatric inpatients were marital status, presence of personal psychiatric history, presence of criminal history and hospitalization modalities.

The results of our study were generally consistent with the data in the literature.

The most recent legal regulations in the Republic of Croatia govern the process of criminal procedure for persons in pre-trial detention who have a temporary mental disturbance for which psychiatric treatment is needed. The Prison Director is in this case obliged to seek psychiatric treatment for such persons who are then hospitalized in a psychiatric institution instead of a prison hospital or prison that meets the requirements prescribed by law for the accommodation of pre-trial detainees. Forensic departments of the five psychiatric hospitals in Croatia accept mentally incapable persons subject to court order, but not persons in custody, i.e. in pre-trial detention. Pre-trial detention is a measure imposed in the previous proceedings to ensure that the person to whom the measure is imposed is present during the pre-trial stage and the hearing stage, i.e. after the final judgment has been rendered until it becomes final. According to Croatian laws, a person who has been sentenced to pre-trial detention and who has mental disorders is entitled to a range of rights that must be respected, and at the same time, there are strict restrictions in exercising those same rights for the reason of sentencing to pre-trial detention.

The article points to several problems that have arisen in practice due to the under-regulation of pre-trial detention measures.

Perspective, opinion, and commentary article.

Perspective, opinion, and commentary article.

The authors discuss legal, medical, and ethical issues, but also the financial framework of such a process.

Violence between brothers and / or sisters is one of the most important forms of violence within families. To understand homicides between them, the hypothesis of rivalry has been put forward. But how is it really in reality?

To construct both the clinical and medicolegal profile of perpetrators of fratricide and sororicide.

This is a retrospective study of 12 cases of fratricide, which were examined in the context of criminal psychiatric expertise in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2002 and December 2018.

The mean age of offenders was 31.9 years; they were all male. Eight fratricide perpetrators were unmarried and had an irregular occupation. They had a psychiatric follow-up prior to homicide in 5 cases. Previous criminal records were noted in one third of the cases. Three perpetrators of fratricide were using psychoactive substances. History of violence against the victim was presented in 7/12 of cases, and the victim was younger than the perpetrator in 5 cases. Aggression was premeditated in 4 cases. The knife was the most used weapon (11/12). Seven offenders suffered from a major mental illness. The most common diagnosis was schizophrenia (6/12). The experts had concluded that 8 cases were in a state of insanity at the time of the offense.

Our data indicates that fratricides are lack preparation and most often preceded by violence. It seems to be important to do other researches to assess psychopathology and assess risk factors for fratricide.

Sexual offenders are classified in terms of the act they have committed, diagnosis of sexual preference disorder (paraphilic disorder), and the potential motives behind the act. The typology that is often used in forensic-sexological practice is the division into preferential and non-preferential perpetrators, i.e. perpetrators showing or not showing a sexual preference disorder.

The aim of the study was to assess whether psychosocial and personality variables significantly differ between the group of preferential and non-preferential sexual offenders.

The study involved 120 persons, including 60 preferential and 60 non-preferential sexual offenders. The participants were presented with selected, standardized psychological tools to personality traits, self-esteem, life satisfaction, capacity to understand emotions, attachment style.

The study involved 120 persons, including 60 preferential and 60 non-preferential sexual offenders. The participants were presented with selected, standardized psychological tools to personality traits, self-esteem, life satisfaction, capacity to understand emotions, attachment style.

Differences between the both study groups and the male standardization sample suggest worse psychosocial functioning of sexual offenders. A critical analysis of the methodological limitations of this study have been presented.

Scientific work was financed from the budget for science in the years 2017-2021, as a research project DI 16/003046 under the programme „Diamond Grant”.

In February 2020, the Central Mental Hospital Dundrum moved to a complete ban on cigarette smoking. Concerns were raised that this might represent a ‘restrictive practice’ and that patients might gain weight or see changes in their blood pressure if they were not permitted to smoke.

The aim of the study was to ascertain if there were changes in the blood pressure readings or body mass index of a group of patients in a secure forensic hospital after the implementation of a complete campus-wide smoking ban

All patients (n=20) working with one medium cluster team were included in the study. Demographic details and data pertaining to legal status, diagnosis and length of stay in the hospital were obtained. BMI, blood pressure and medications were reviewed at the time of introduction of the smoking ban, 1st February 2020 and again 5 months later.

All those included in the study were male. The median age was 35 years, most common diagnosis was schizophrenia and mean length of stay was 4.23 years. 20% of patients were prescribed anti-hypertensives at the time of introduction of the smoking ban. All of the patients on anti-hypertensives were overweight. At follow up there was no increase in BMI noted in the patient group. Two patients had dose reductions in anti-hypertensives, three had discontinuation of bronchodilators.

Introducing a campus wide smoking ban in a secure forensic psychiatric hospital is both clinically positive and practically possible. There was no noted increase in incidents in the hospital during this period.

In the mental health area, the most problematic issues are the involuntary placement of the mentally ill in closed institutions, both under civil and criminal proceedings, and their involuntary treatment. Despite the international efforts of harmonizing measures, the nature and practice of the services still vary from country to country.

To analyse involuntary placement of persons with mental disorders in closed institutions under civil and criminal proceedings, which include both psychiatric hospitals and care institutions.

Review and analysis of regulations and practice of involuntary placement of a person with a mental disorder in a closed institution in the context of Estonian, Finnish, Russian, and English law, health care and social system.

Estonian, Finnish, Russian, and English law distinguish between criminal and civil proceedings regarding involuntary placement of a mentally ill person in a closed institution. However, specifics of the proceedings are different among the countries, e.g. judicial involvement, and deadlines. Also, the provision of forensic mental health services differ among these countries, e.g. in Estonia offenders and non-offenders are kept separately, whilst in England and Russia patients are not distinguished so strictly.

The distinction between involuntary placement of the mentally ill in criminal and civil proceedings is distinguished primarily for the reason that in one case the risk arising from the person is directly realized by committing an unlawful act and in the other case the risk arising from the person is directed at themselves or is not qualified as an unlawful act.

Paranoia querulans is a type of persistent delusional disorder of the persecutory subtype, recognized under ICD-10 and DSM-IV. Being a classically described entity, evidence is lacking from its conceptualization as a nosological entity to diagnosis and treatment. Furthermore, controversy still exists regarding its interplay between the judicial and mental health systems.

To summarize current evidence and knowledge regarding Paranoia querulans on its conceptualization, ethiopathological explanations, therapeutical management and interface between psychiatry and the law.

A systematic review was undertaken between June and October 2020 in the PubMed, Web of Science and Scopus databases according to PRISMA directive. Key-terms: ((querul* OR vexatious) AND (paranoia OR delusio* OR neuros* OR behavi* OR complai*) OR litig*) AND psychiatry. No language or time restrictions were established.

A total of 1648 studies were initially identified (PubMed: 679; WOS: 945; Scopus: 24; other: 0); after duplicates were removed, n=1381 studies remained. After screening title and abstract, 56 studies were included. Their main content was categorized into: 1. Conceptualization (n=26): Neurosis (n=5), psychosis (n=9), behavioral disorder (n=5); no psychiatric diagnosis (n=7). 2. Descriptive psychopathology (n=8) 3. Etiopathogenesis (n=9): Social or personality basis (n=3), culture (n=4), trauma (n=1), cognitive decline (n=1) 4. Management (n=1) 5. Psychiatry and Law: same object, different objectives (n=12)

There is controversy regarding the nosological entity of querulousness, from psychosis to neurosis or behavioral disorders. Some authors consider this behavior to not be a psychiatric diagnosis. Furthermore, most papers dealt with a social or nurture-based origin. There is a dearth of information regarding treatment.

JPE has received CME-related fees from Lundbeck.

Nowadays, many relevant gene-drug associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health-care.

To address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of pharmacogenomics testing for the prescription of antidepressants and antipsychotics.

Our initial screening revealed 1159 articles, which was subsequently reduced to 32 articles, deducted by analysis of their abstract. Full-text analysis performed by all authors resulted in 18 papers that were further included in the analysis.

Of the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) were cost-effective and 7 (38.9%) were less costly based on cost analysis. In brief, we found sufficient evidence on the cost-effectiveness of PGx in psychiatric disease care. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 gene-drug associations and for combinatorial PGx panels, but evidence is limited for many other drug–gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs in many economic studies, as well as the underreporting of study design elements, which can influence significantly the economic evaluations.

Overall, this systematic review highlights the need for additional research on economic evaluations of PGx implementation with an emphasis on psychiatric pharmacogenomics.

The identification of potential biomarkers is crucial to improve the management and treatment of mood disorders. Glycogen synthase kinase-3 (GSK-3) is a multifunctional enzyme with an important role in the etiology of mood disorders. Recent findings suggested GSK-3 as a putative biomarker in mood disorders.

The aims of the study are: - to evaluate GSK3 as potential biomarker for differential diagnosis (MDD and BD); - to analyze the regulation of GSK3 by psychopharmacological treatments.

Patients included fulfill the following criteria: (a) principal diagnosis of MDD or BD (DSM-5); (b) age ≥ 18 years; (c) drug-free for at least 4 weeks before the inclusion. For each patient included a healthy control is enrolled, matched by gender and age. All included subjects at the study entry point (t0) are assessed through: - semistructured clinical interview and clinical rating scales (Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale; Young Mania Rating Scale, Clinical Global Impression) - blood draw, to measure GSK-3 levels Patients with MDD or BD are assessed again after 1 week (T1) and after 2 month (T2) of specific pharmacological treatment.

So far, we enrolled 16 patients and 16 healthy controls. The enrollment is still ongoing.

We expect to find GSK-3 levels differently expressed between healthy controls, patients with DDM and patients with BD. This finding would be crucial as it could contribute to the improvement of differential diagnosis. Moreover, we expect to observe a change in GSK-3 levels after psychopharmacological treatments.

Neural stem/progenitor cells derived from olfactory neuroepithelium (hereafter OE-NS/PCs) are emerging as a viable proxy and a valuable tool for translational studies on severe mental illnesses (SMI). In this respect, the use of OE-NS/PCs as a surrogate cellular model of schizophrenia (SZ) has enabled insights into cell signaling and cell cycle dynamics in this disease.

We explored whether mitochondrial dysfunction, which has been already associated with SZ, may have a role in the altered proliferation pattern previously observed in OE-NS/PCs of SZ patients.

OE-NS/PCs were collected from 20 patients and 20 healthy controls (Hcs) by nasal brushing, cultured in proper medium and expanded. Fresh OE-NS/PCs at passage 3 of both groups underwent BrdU proliferation assays or were frozen for later use. Mitochondrial ATP production was measured in both fresh and thawed OE-NS/PCs by using the ATPlite Luminescence Assay kit.

Fresh OE-NS/PCs of patients grew at a higher rate than those of HCs (M-W U=0; p<0.001), whereas the proliferation of thawed OE-NS/PCs of both groups exhibited an opposed pattern (at passage 6, p=0.002). Mitochondrial ATP production was significantly lower in OE-NS/PCs of patients than in those of HCs (M-W U=0; p=0.02), regardless of freeze-thaw conditions (M-W U=6; p=0.77).

Mitochondrial ATP production is negatively affected in OE-NS/PCs of SZ patients as compared to those of HCs. This evidence does not differ in fresh OE-NS/PCs and OE-NS/PCs undergoing freeze-thaw cycles, which instead perturb the proliferation pattern of SZ OE-NS/PCs.

Metabolic disturbances are common in patients maintained on neuroleptics. These abnormalities significantly increase the physical comorbidity and mortality rates due to cardiovascular disease. We hypothesized that 5-HT receptor genes polymorphisms have associations with drug-induced metabolic syndrome development in schizophrenic patients.

To investigate the role of polymorphic variants of serotonin receptors genes in the development of antipsychotic-induced metabolic syndrome.

467 patients with schizophrenia receiving long-term antipsychotic therapy were investigated. The mean age was 40.0±11.6 years. The standard phenol-chloroform method for DNA isolation was used. Genotyping was carried out on eight SNP’s of genes HTR1A, HTR2A, HTR3A and HTR2C with the MassARRAY® Analyzer 4 (Agena Bioscience™) using the set SEQUENOM Consumables iPLEX Gold 96 on the base The Core Facility “Medical Genomics”, Tomsk NRMC.

The prevalence of metabolic syndrome was 26.1%. In the study sample, there were significantly more women with metabolic syndrome (56.6%) than men (43.4%) (p=0.002). The majority of patients with metabolic disturbances were aged >40 years (62.3%), versus 40.9% in the group without metabolic disorders (p<0.001). The duration of the disease was statistically significantly higher in the group of patients with metabolic syndrome (p=0.003). We did not find statistically significant associations of polymorphic variants of the studied genes with the development of the drug-induced metabolic syndrome.

Our results do not demonstrate any significant association between allelic variants of serotonin receptor genes and metabolic syndrome in patients with schizophrenia. Conflict of interest. The authors declare no conflict of interest. Supported by Grant of RSF 19-75-10012.

Medication is primary tactics in schizophrenia treatment. First and second generation antipsychotics (FGA and SGA respectively) affect on core symptoms. Unfortunately, it causes side effects. Metabolic syndrome one of them and includes large number of affections like body mass index changes, lipidemias, hypertension and others.

To study the role of polymorphic variants FTO gene in metabolic syndrome in schizophrenia patients.

We were investigated 480 patients. Main criteria for inclusion in study was using antipsychotics, verified diagnosis of schizophrenia and metabolic syndrome. Mean age was 42,1±1,4 years. The metabolic syndrome was assessment based on clinical data. Standard phenol-chloroform protocol for DNA isolation was used. Genotyping was carried out on six SNP’s of FTO gene with real-time PCR. Statistical analysis was carried out with R 3.6.2 with basic functions and SNPassoc package.

The distribution of genotypes for variants rs7185735 and rs9939609 was not in according to Hardy-Weinberg equilibrium (a p-value less than 0.05) and excluded from further analysis. Patients with schizophrenia were divided into two groups: patients with metabolic syndrome and patients without it. We did not identify any statistically significant associations between genotypes and alleles of FTO gene and metabolic syndrome.

We did not find any associations of alleles and genotypes of FTO gene with metabolic syndrome in schizophrenia patients from Siberia region. Metabolic syndrome needs more further studies with larger number of samples and different populations. Conflict of interest. The authors declare no conflict of interests. Supported by Grant of RSF 19-75-10012.

Patient microaggressions and hate speech affect practitioners in all fields of healthcare. In some facilities, 100% of healthcare workers report experiencing harassment and hate speech, with the aggressors most frequently being patients. To date, there has been no systematic review of policies, recommendations and trainings on patient microaggressions and hate speech against healthcare professionals.

A systematic review was conducted to identify recommendations and solutions for healthcare professionals on responding to patient microaggressions and hate speech. Additionally, websites of major healthcare professional organizations and the 6 largest healthcare systems were checked for policy statements related to discrimination by patients towards healthcare providers.

A literature search of PubMed, PsycINFO, Medline, ERIC and MedEdPORTAL. Articles that contained recommendations and trainings for responding to microaggressions and hate speech were retained. 13 Leading professional organizations and 6 healthcare systems were checked for policies on discrimination by patients.

Our review identified 27 studies providing recommendations and trainings for healthcare professionals to address patient hate speech and microaggressions. Three professional organizations but no healthcare systems had policies on discrimination by patients.

Seven trainings that equip providers with tools to address patient microaggressions and hate speech were identified. Trainings included the ERASE framework; Stop, talk, and roll; interrupting microaggressions; and the OWTFD tool. Nineteen studies outlined recommendations for healthcare professionals and systems on how to respond to patient offenses. Professional organizations and healthcare systems need to create policies to support healthcare professionals who face microaggressions and hate speech.

Intellectual disability is a condition of cognitive impairment and deficit in adaptive skills. Mental illness is frequent in people with intellectual disability. As a result antipsychotics are often prescribed to treat not only mental illness but also problem behaviors.

Perform a literature search about intellectual disability and antipsychotics.

A non-systematic literature review was performed on PubMed using the keywords “intellectual disability” and “antipsychotics”. All papers published between 2015 and 2020 were evaluated.

A review of the literature reveals that antipsychotics are the most frequently prescribed psychotropic drugs in people with intellectual disability. However, results from the studies are ambiguous. Several studies showed that antipsychotics are effective in improving problem behaviours, nevertheless some recent studies showed no significant difference in the outcomes between antipsychotics and placebo

Even though antipsychotics are prescribed in people with intellectual disability, evidence to support their use is lacking. In consequence, clinicians should consider the pharmacological approach as a part of an integrative treatment. Assessing adverse events, drug effects and the possibility of decreasing dose of antipsychotics is crucial.

Learning Difficulties relates to significant and unusual difficulties in the acquisition and use of one or more of the following areas: listening, speaking, reading, writing and mathematical skills. In the last twenty years, following the research conducted by cognitive psychology, from neuropsychology, from pedagogy and from the confrontation between educators and psychologists, the attention was focused on the cognitive modalities of the subjects engaged in learning tasks.

Thanks to the study of cognitive styles and Learning Styles thelearning subject was placed at the center of the educational project, stimulating from on the one hand there is also reflection on teaching styles and the most appropriate ones methodologies, teaching methods and methods of approaching the individual disciplines and, on the other hand, prompting clinicians to research around the intellectual peculiarities of each subject and a outline a descriptive criterion of his / her cognitive functioning profile.

The intellectual scale (WISC IV) of 32 children (aged between 7 and 15 years) with specific learning disabilities was analyzed, in order to highlight the underlying intellectual functioning and any cognitive styles.

According to the international scientific literature, the results show a greater fall in the area of working memory, followed by the cognitive domain concerning processing speed.

In detail, by analyzing the individual subtests, greater difficulties are noted, at all ages, in the processes of abstraction and conceptualization, in short-term auditory memory, in the speed of processing and visual-praxic motor coordination.

Intellectually disabled people are vulnerable to somatic and mental illnesses, often presenting behaviour changes. Moreover, difficulties in describing symptoms can limit their access to healthcare system and adequate treatment.

Through a case report, we aim to provide an overview on behaviour changes in people with intellectual disability (ID), emphasizing the screening for organic conditions.

Description of a clinical case and a qualitative review about the assessment of behaviour changes in persons with ID, using PubMed database.

We present a clinical case of a 57-year-old man with history of ID, alcohol and tobacco abuse and Epilepsy. He had previous acute psychiatric admissions due to behaviour disorganization and irritability. In January he was admitted with disorganized behaviour and caregiver exhaustion, and stabilized with Olanzapine 20mg/day. On the 28th day of hospitalization, he fell of his of bed and suffered a mild traumatic brain injury. Cerebral CT scan revealed two metastatic lesions in the brain. Further investigations found out primary neoplastic lung lesion and multiple metastasis. Afterwards, his relatives mentioned a heavy familiar history of cancer and that he had postural instability signs that they did not value.

Although psychiatric disorders are common in patients with ID, we must always remind that behaviour changes can mask the presentation of an organic disease. Despite a long follow-up in Psychiatry, organic conditions should be considered when patients with ID present behaviour changes. Further studies are needed in the assessment of this particular population to provide proper medical, psychological and social care.